Risk Aware Urethral Play

From this article on Fearless Press

Some key points:

When it comes to complications the two main types are infectious complications and trauma related complications. Simple urinary tract infections (cystitis) can rapidly progress to kidney infections (pyelonephritis) and from there bacteria can readily cross into the blood stream causing sepsis.

The CDC [Centre for Disease Control] classifies equipment as critical, semi-critical and noncritical based on their ability to infect a patient if they are contaminated with microorganisms. This classification will then dictate how they should be cleaned between uses. Critical items confer a high risk for infection if they are contaminated. This category includes surgical instruments and urinary catheters. Most of the items in this category should be purchased as sterile or be sterilized with steam if possible. An acceptable alternative is germicides categorized as chemical sterilants. Chemical sterilants are only reliable if proper guidelines are followed regarding concentration, contact time, temperature, and pH. The bottom line is that when using sounds a responsible Dom/me is going to use a sterile technique and properly sterilized equipment when playing in the urethra. Alcohol alone isn’t going to be sufficient. Alcohol will only kill about 70% of the microorganisms on a surface and doesn’t inactivate spores.

Physical trauma is always a concern when engaging in urethral play. Sounds should be used as a set starting small and working up to larger sizes. Starting large may not allow the smooth muscle surrounding the urethral mucosa to accommodate to the size of the sound and could result in tearing. Similarly, a sound should never be forced. If you meet resistance applying too much pressure could result in the creation of a false passage. This could result in urine passing into spaces parallel to the urethra and increases the risk of infection, abscess formation and bleeding. When playing with sounds a forced passage is a false passage. One of the major dangers of causing physical trauma to the urethra is that it can result in scarring and the creation of a urethral stricture.

And this is an excerpt from an NHS page about urethral dilation:

An antibiotic injection is given as a precaution against infection. The area around the end of the urethra is then cleaned with an antiseptic solution. After this, local anesthetic lubricant gel is inserted into the urethra. For female patients, the gel is applied to the dilator instead.

And lets be honest, the NHS is constantly cutting costs. They are not going to ‘waste’ a preemptive antibiotic injection on someone if it is not considered an important precaution.

Precautions not mentioned but that we advise:

  • Use of sterile fields (such as sterile crepe paper from a wound care kit) around the urethra
  • Use of sterile lubricant from single use sachets
  • Use of sterile gloves that are changed regularly to minimize contaminants passed from surroundings/other kit to the sounds and urethra

Sterile technique is not simply about using ‘clean’ equipment. The very act of sounding (or any other play where sterile technique is recommended) must be conducted in a manner that minimizes the risk of contamination and infection. Do NOT touch the sounds once sterilized without sterile gloves, do NOT use the same pair of gloves to prepare the play and to perform the play, do NOT touch the disinfected area/sterile area with bare hands or contaminated gloves, do NOT pick something up (such as a camera) and then resume the play without changing gloves, use sterile technique when changing gloves so the outside surface of the gloves is not contaminated, do not scratch your face or wipe your nose, etc.

Sterile (also known as aseptic) is a very particular level of cleanliness. It means free of microorganisms and contaminants and particular processes must be followed to ensure sterility. Using antiseptic solutions, alcohol or boiling water is NOT sufficient to sterilize. Cold sterilizing solutions are available from medical suppliers and alternatively an autoclave is used (look up ‘pressure cooker sterilization’ for a budget, at-home version).

Infections in the blood stream can and do kill people. Don’t take risks unless you know what you’re getting into. Please carefully research play before engaging in it and discuss the risks in full with your play partners.